Glomus tumour: an institutional experience of 31 cases.

BACKGROUND: Glomus tumour is an uncommon soft tissue tumour which commonly occurs in the distal extremities, particularly the subungual region of the finger. Due to its rarity, there is a paucity of literature concerning glomus tumour. Therefore, this paper aims to report a case series based on our institution's experience. METHODS: A retrospective cross sectional study was performed in a single tertiary institution in Singapore. All patients diagnosed with glomus tumour confirmed on histology from January 2019 to October 2022 were included in the study. Patient demographics and clinical information (presenting signs and symptoms, tumour parameters and presence of recurrence) were retrieved from existing medical records. RESULTS: A total of 31 cases of glomus tumour were diagnosed from January 2019 to October 2022, and the relevant demographics and clinical presentation were reported. Majority of glomus tumours occurred in the finger (61.3%). Pain was present in almost all the cases (96.8%), while a lump was visible in less than half (48.4%). An average of 44.0 months elapsed before patients were properly diagnosed and treated. There were no cases of recurrence despite involved margins in three cases. CONCLUSION: Glomus tumour can be easily missed if clinicians do not have an index of suspicion for it, resulting in delayed treatment. Once diagnosed, glomus tumour can be treated with complete excision with good outcomes.

The modified fascial sling technique for ulnar nerve anterior transposition: surgical techniques and results.

Background: Approaches to surgical treatment to cubital tunnel syndrome include simple decompression, decompression with medial epicondylectomy, and decompression with anterior transposition of the ulnar nerve. Transposition of the ulnar nerve involves decompression and transposition of the nerve anteriorly to a subcutaneous, intramuscular, or submuscular position. However, transposing the ulnar nerve to subcutaneous plane renders it more susceptible to external trauma. Hence, this technique article introduces the use of a modified fascial sling. Methodology: The modified fascial sling technique for anterior transposition of the ulnar nerve involves careful dissection to identify the ulnar nerve, decompression of the nerve, then transposition of the ulnar nerve anterior to the medial epicondyle. An AlloWrap (Stryker, Kalamazoo, MI, USA) is first wrapped around the ulnar nerve, followed by wrapping a fascial sling fashioned from the flexor carpi ulnaris fascia. A prospective case series for this surgical technique was conducted. Wilcoxon signed-rank test compared preoperative and postoperative qDASH-9 scores, an abbreviated questionnaire to assess functional limitations of the upper limb. Results: Five patients were included in this study, with a mean duration of follow-up of 530.4 days. The mean QuickDASH-9 functional disability score was 36.5 ± 25.1 preoperatively and 20.6 ± 12.8 postoperatively, demonstrating statistically significant improvement (P = .008). Conclusion: The modified fascial sling technique for anterior transposition of the ulnar nerve was developed to address the complications of perineural adhesions after transposition causing tethering of the ulnar nerve. At the same time, the fascial sling prevents posterior subluxation of the ulnar nerve back to its original location, thereby reducing the risk of recurrent symptoms.

Diagnosis and treatment of avascular necrosis of the humeral head: Current concepts.

Avascular necrosis (AVN) of the humeral head is an uncommon clinical entity which can result in significant morbidity for patients. There is a paucity of literature concerning humeral head AVN, which may be due to the relatively rarity of the condition and poorly understood nature. Despite being first described decades ago, the underlying pathophysiology leading to humeral head AVN is still poorly defined. While the staging of humeral head AVN is well described, not much is known about prognosticating factors to predict the eventual course. Most of the management options are based on that of femoral head AVN, and even so, there is a paucity of good quality clinical trials in the literature. This current concepts paper describes what is known about humeral head AVN and proposes a management algorithm to guide clinicians.

Clinical outcomes of meniscus repair and partial meniscectomy: Does tear configuration matter?

PURPOSE: We report our experience with the effect of location and configuration of meniscal tears on clinical outcomes. METHODS: A retrospective review of patients who underwent partial meniscectomy or meniscal repair between 2008 and 2016 was conducted. One hundred fourteen knees in 106 patients were included, comprising 43 partial meniscectomies and 71 meniscal repairs. Patients were graded pre- and postoperatively with the International Knee Documentation Committee (IKDC) score and Tegner Activity Level Scale. Meniscal tears were classified according to location (anterior horn, body, posterior horn, and others) and type (radial, horizontal, longitudinal, and complex) and subgroups were analyzed for their effect on outcomes. RESULTS: All tears, whether treated with partial meniscectomy or repair, showed significant improvement in postoperative scores (p < 0.05); 39.47% of tears involved the posterior horn alone, 10.53% involved the body alone, 3.51% involved the anterior horn alone, and 46.49% were complex tears that spanned more than one area. Complex tears treated with repair had significantly better scores (IKDC, p = 0.002; Tegner, p = 0.008) than complex tears treated with meniscectomy. Longitudinal tears showed results suggesting better short-term outcomes with meniscectomy than with repair (IKDC, p = 0.036; Tegner p = 0.018), a potential statistical anomaly. Horizontal and radial tears showed no significant difference in outcomes, regardless of treatment. Tears in different locations (anterior horn, body, posterior horn, and others) showed no significant difference in outcomes, regardless of treatment. CONCLUSION: Meniscal surgery yields significant improvement in postoperative scores. Complex tears showed significantly better postoperative scores when treated with repair.

Factors influencing communication of traditional Chinese medicine use between patients and doctors: A multisite cross-sectional study.

OBJECTIVE: In Singapore, the use of traditional Chinese medicine (TCM) alongside Western medicine (WM) is common. There are risks of adverse herb-drug interactions when taken concurrently. Current literature suggests that TCM use is not regularly reported to WM doctors in Singapore, but the underlying reasons are not understood. METHODS: A cross-sectional study was conducted across Singapore by administering questionnaires to TCM-using patients and WM-practising general practitioners (GPs). The questionnaire examined the following themes: (1) demographics and TCM use pattern; (2) respondents' (patients and GPs) knowledge and beliefs about TCM and the factors influencing the discussion of TCM during the WM consultation; and (3) respondents' qualitative suggestions to increase disclosure rate. RESULTS: A total of 484 patients and 334 GPs were surveyed. Factors associated with patients' initiation of TCM discussion include length of consultation (odds ratio [OR]: 2.1; P < 0.001), comfort level in discussing TCM (OR: 1.6; P < 0.001) and belief in importance of discussion (OR: 1.4; P = 0.017). Doctor's initiation of discussion (74%) was the top patient-ranked factor influencing their discussion of TCM. For doctors, knowledge of TCM indications (OR: 2.2; P < 0.001), belief in importance of discussion (OR: 2.1; P < 0.001) and comfort level in discussing TCM (OR: 1.9; P = 0.001) were associated with their initiation of TCM use discussion. Possible WM-TCM interactions (58%) was the top doctor-ranked factor influencing their discussion of TCM. CONCLUSION: The discussion of TCM in a WM setting is multifactorial. Interventions include doctors' active screening for TCM use in patients and equipping doctors with TCM knowledge. Improving communication between patients and doctors is key to avoiding harmful herb-drug interactions.

Save the meniscus - Clinical outcomes of meniscectomy versus meniscal repair.

PURPOSE: This study was designed to compare the clinical outcomes of meniscectomy versus repair and to study the effects of (1) duration of follow-up and (2) concomitant anterior cruciate ligament (ACL) reconstruction on clinical outcomes. METHODS: A retrospective study was conducted, involving 112 knees of 106 patients who underwent meniscus surgery, either partial meniscectomy or meniscal repair between 2008 and 2016. There were 42 meniscectomies and 70 meniscal repairs. Patients were graded pre- and post-operatively using the International Knee Documentation Committee (IKDC) score and Tegner Activity Level Scale through case notes review. Statistical analysis was done using the paired Student's t-test (two-tailed) or Wilcoxon signed-rank test for paired scores. The two-sample Student's t-test (two-tailed) or Mann-Whitney U test was used for independent scores. Multiple variable linear regression analysis was used to assess the importance of the variables on outcomes. A statistical significance is taken as p < 0.05. RESULTS: Meniscectomy and repair had good outcomes. IKDC scores improved from 46.6 to 81.7 after meniscectomy and from 45.9 to 84.4 after repair ( p < 0.001). Meniscectomy fared worse in late follow-up (>18 months), decreasing from 88.2 in early follow-up (≤18 months) to 72.1 ( p < 0.05). The post-operative scores in meniscal repair were maintained in the late follow-up group (82.9 compared to 87.1, p > 0.05). Concomitant ACL reconstruction improved the outcomes of meniscectomy (IKDC and Tegner: p < 0.05) and repair (IKDC and Tegner: p < 0.05). CONCLUSION: Both meniscectomy and meniscal repair are viable surgical techniques for meniscal injury and have good outcomes. Meniscal repair has a better prognosis in the long run.

Modern-day palliative chemotherapy for metastatic colorectal cancer: does colonic resection affect survival?

BACKGROUND: Patients with metastatic colorectal cancer (mCRC) with surgically incurable metastases would be recommended for palliative chemotherapy (PC). The role of surgical intervention is debatable with no conclusive evidence for routine primary tumour resection (PTR) or stoma creation. We aimed to study if surgical intervention conferred a survival benefit in patients with mCRC who received upfront systemic therapy. METHODS: A retrospective review of a prospectively collected database in a single centre was performed. Patients diagnosed with mCRC from January 2004 to December 2014 were included. We excluded patients who had an upfront surgical intervention, had no treatment with systemic therapy or had attained curative resection. The decision for surgery was based on the outcome of a multidisciplinary tumour board. Demographic, clinicopathological, treatment and follow-up data were collected. Univariate and multivariate analyses were performed. RESULTS: Out of 408 patients with mCRC with incurable metastases, we analysed 124 patients who had upfront PC. Twenty-nine had PC + PTR (group A), 10 had PC + stoma (group B) and 85 had PC only (group C). Undergoing PTR led to significant improvement in overall survival (OS; 30.8 versus 13.4 versus 11.0 months, P < 0.001). With multivariate analysis, undergoing PTR and receiving biologics were independent good prognostic variables. Surgical resection was safe with minimal complications. CONCLUSIONS: PTR was found to increase OS while stoma creation had no impact on OS. The benefits and safety of undergoing PTR may be a result of selection bias. Further prospective studies are required to confirm the observations of this study.